Town of Union Vale, NY Chapter 43 Health Insurance Policy

[HISTORY: Adopted by the Town Board of the Town of Union Vale 1-9-2003 by L.L. No. 1-2003 (Ch. 10 of the 1983 Code). Amendments noted where applicable.]

§ 43-1 Eligibility.

A. All full-time employees and all elected officials will be eligible for health benefits under the designated primary carrier and other approved medical plans for health insurance coverage.

B. Part-time employees with 20 hours are eligible for health benefits if approved by Town Board resolution. The full cost of the plan selected is to be paid by the employee.

C. Retirees are eligible for health benefits in accordance with the provisions of § 43-3.

[Added 12-14-2006 by L.L. No. 2-2006]

D. Eligible separated employees are eligible to enroll in the Town health insurance plan at their own cost and expense in accordance with the provisions of § 43-7.

[Added 12-14-2006 by L.L. No. 2-2006]

E. As used in this chapter “Completion of Town Service" shall be defined as:

[Added 12-14-2006 by L.L. No. 2-2006]

(1) For an employee, the last day for which the employee was compensated; or

(2) For an elected official, the last day of the official's term of office.

§ 43-2 Individual, double and family coverage.

A. All full-time employees and all elected officials shall have the option of choosing single, double, or family coverage. If both spouses are Town employees or elected officials, the Town shall provide two individual plans. One spouse may request a family plan, if approved by the Town Board.

B. The Town Board may, at its discretion, change carriers and/or offer an alternative plan. The Town Board shall designate a primary carrier. Thereafter, an employee, elected official or retired employee shall have the ability to select a carrier from the designated primary carrier or other approved carriers. However; it will be the responsibility of that individual to pay the difference between the designated primary premium and the approved plan premium they have selected. This payment shall be by payroll deduction for employees or elected officials and by monthly payment by retirees.

C. The Town will pay the full premium of the designated primary carrier for individual, double or family medical insurance coverage, as the case may be, for each eligible full-time employee or elected official working prior to January 1, 2003. After January 1, 2003, the portion of the premium paid by the Town may be subject to change each year at the discretion of the Town Board.

§ 43-3 Coverage after retirement.

[Amended 6-12-2003 by L.L. No. 4-2003; 1-8-2004 by L.L. No. 1-2004; 12-14-2006 by L.L. No. 2-2006]

A. "Eligible retiree" shall be defined as a full-time employee or elected official who:

(1) Is employed by the Town of Union Vale on the date of retirement or, if an elected official, has submitted an application for retirement benefits within three months of the completion of his or her final term of office; and

(2) Has attained the applicable retirement age according to the laws, rules and regulations of the New York State Retirement System; and

(3) Is credited with 10 or more consecutive years of service with the Town of Union Vale immediately preceding the date of retirement; and

(4) Has been continuously enrolled in a health insurance plan provided by the Town for at least two years immediately prior to completion of Town service; and

(5) Is entitled to receive a retirement allowance or pension from the New York State Retirement System on the completion of Town service or within 90 days thereof.

B. "Vested employee" shall be defined as a full-time employee or elected official who:

(1) Has been continuously enrolled in a health insurance plan provided by the Town for at least two years immediately prior to completion of Town service; and

(2) Separates from Town service other than by death or retirement; and

(3) Is credited with 10 or more years of service with the Town of Union Vale; and

(4) Is and remains entitled to receive at a future time a retirement allowance or pension from the New York State Retirement System; and

(5) Such person shall remain a vested employee until:

(a) He or she withdraws from coverage under the health insurance plan; or

(b) His or her status as a vested employee is terminated for failure to pay the premiums required under the health insurance plan; or

(c) His or her entitlement to such future retirement allowance or pension from the New York State Retirement System is terminated; or

(d) He or she commences to receive such retirement allowance or pension from the New York State Retirement System, in which latter case he or she shall become an eligible retiree; or

(e) The Town Board terminates the health insurance plan.

C. Eligible retirees.

(1) Eligible retirees are entitled to receive post-retirement health benefits, provided:

(a) The eligible retiree has notified the Town of his or her election to receive post-retirement health insurance coverage at the time the employee or elected official submits an application for retirement with the Town. This notification must be submitted prior to the eligible retiree's completion of Town service; and

(b) The eligible retiree shall pay the cost of the premium, less the contribution of the Town, which shall be equal to 50% of the premium for the coverage of an individual under the primary plan offered by the Town.

[1] A retiree may select from the plans offered by the Town pursuant to § 43-2.

[2] If an eligible retiree chooses to select an approved plan other than the individual plan of the primary carrier designated by the Town, any difference in the premium amount must be paid monthly in advance by the retiree.

[3] The eligible retiree must remit the premium payment to the Town no later than the 19th day of the month preceding the month for which coverage is provided. If coverage is terminated within the subsequent 60 days due to lack of payment, the beneficiary shall have the right to reinstate coverage making full payment of premiums up to and including the payment due for the month when payment is made. After 60 days of nonpayment, the Town may, at its option, permanently terminate coverage.

(2) The contribution that the Town makes toward the premiums of eligible retirees is subject to change by the Town Board on a yearly basis.

D. Vested employees.

(1) A vested employee may continue his or her health insurance coverage offered by the Town pursuant to § 43-2 if the person:

(a) Has notified the Town of his or her election to continue in the health insurance coverage prior to completion of Town service; and

(b) Pays all premiums and fees due for the coverage while the person is a vested employee. The eligible separated employee must remit the premium payment to the Town no later than the 19th day of the month preceding the month for which coverage is provided. If coverage is terminated within the subsequent 60 days due to lack of payment, the beneficiary shall have the right to reinstate coverage, making full payment of premiums up to and including the payment due for the month when payment is made. After 60 days of nonpayment, the Town may, at its option, permanently terminate coverage.

(2) Provided that a vested employee has made all of the required premium payments and continues to be enrolled in the plan, he or she shall become an eligible retiree when he or she commences to receive a retirement allowance or pension from the New York State Retirement System.

E. Elected officials and employees receiving benefits prior to the effective date of this section, shall continue to receive benefits as provided, as long as they have selected the primary plan designated by the Town.

§ 43-4 Coverage of surviving spouse on death of retiree.

If the retired employee or elected official should die, the surviving spouse shall retain the option of continuing health insurance coverage previously received under § 43-3 above under the same terms that previously applied, for a period of six months.

§ 43-5 Coverage of surviving spouse on death of active employee.

If any full-time employee or elected official with health insurance coverage shall die while in service to the Town, the spouse shall be eligible to continue coverage for a period of six months as defined in § 43-3 above.

§ 43-6 Medical insurance buyout.

A. Any full-time employee or elected official, who is eligible for medical insurance coverage, may elect to receive a cash buyout in lieu of receiving medical insurance benefits. The buyout amount schedule is $350 for the year 2001, $600 for the year 2002, with a cap of 30% of the single premium amount of the designated primary carrier. To be eligible for the medical insurance buyout, the employee must provide documentation of comparable medical health insurance, and sign a waiver of liability to the Town. This request for insurance buyout must be approved by the Town Board. The buyout will be in force for a period of one year and the request must be submitted annually.

B. An employee or elected official will receive an amount set by the Town Board on a yearly basis. This payment will be made once a year through the payroll account. These payments will be reported as income for federal and state income tax purposes.

C. In the event that an employees wishes to reenter the Town insurance plan, restitution must be made directly to the Town on a prorated basis. Coverage will begin on the first of the month immediately following the employee giving notice, provided that the employee gives such notice at least five business days prior to the first of the month.

§ 43-7 Coverage after separation from Town service.

[Added 12-14-2006 by L.L. No. 2-2006]

A. An "Eligible separated employee" shall be defined as a full-time employee or elected official who:

(1) Has been continuously enrolled in a health insurance plan provided by the Town for at least two years immediately prior to completion of Town service; and

(2) Separates from Town service other than by death or retirement; and

(3) Has not reached retirement age; and

(4) Is credited with 10 or more consecutive years of service with the Town of Union Vale; and

(5) Has not been terminated from Town service for cause.

B. An eligible separated employee may continue his or her health insurance coverage offered by the Town pursuant to § 43-2 if the person:

(1) Has notified the Town of his or her election to continue in the health insurance coverage prior to completion of Town service; and

(2) Pays all premiums and fees due for the coverage. The eligible separated employee must remit the premium payment to the Town no later than the 19th day of the month preceding the month for which coverage is provided. If coverage is terminated within the subsequent 60 days due to lack of payment, the beneficiary shall have the right to reinstate coverage making full payment of premiums up to and including the payment due for the month when payment is made. After 60 days of nonpayment, the Town may, at its option, permanently terminate coverage.

C. An eligible separated employee's right to participate in the Town health insurance plan shall expire 10 years from the completion of Town service.

D. This provision shall be in addition to any rights that an eligible separated employee has under COBRA (42 USC § 300bb-1 et seq.).